September 14, 2015
Study Evaluates Risk Factors Associated With Symptomatic PE in Patients Treated With Catheter-Directed Thrombolysis for DVT
September 15, 2015—A study of risk factors associated with symptomatic pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) in lower limbs treated by catheter-directed thrombolysis (CDT) without inferior vena cava (IVC) filter placement was conducted. F.H. Li, MD, et al published the findings online ahead of print in the European Journal of Vascular & Endovascular Surgery (EJVES).
The investigators found that the risk of developing symptomatic PE is most markedly increased in patients with previous silent PE and heart disease; therefore, they concluded that selective (rather than routine) IVC filter placement is an appropriate approach.
As summarized in EJVES, the investigators studied 266 patients with acute/subacute iliofemoral, iliofemoropopliteal, and femoropopliteal thrombosis confirmed by computed tomography venography or ultrasound Doppler. All patients were treated with CDT, with computed tomography pulmonary angiography (CPTA) examination performed in all patients before thrombolysis. Patients with clinically suspected symptomatic PE were confirmed by repeated CTPA after treatment. The major outcome of this study was the occurrence of symptomatic PE events during CDT.
During CDT, there were 13 incidents of symptomatic PE events (13/266, 4.9%). Patients with silent PE had a higher risk of developing symptomatic PE (10/110, 9.1%) than those who had no previous PE (3/156, 1.9%); multivariate analysis confirmed this difference (odds ratio [OR], 4.018; 95% confidence interval [CI], 1.048–15.402). It was also found that patients with previous heart disease had a higher risk of developing symptomatic PE (11/90, 12.2%) than those with no previous heart disease (2/176, 1.1%). Multivariate analysis confirmed that previous heart disease increased the risk of developing symptomatic PE (OR 10.407, 95% CI 2.228–48.617). The investigators reported that one patient who experienced heart failure and silent PE before CDT died of symptomatic PE (1/13, 7.7%).